Epistaxis (nosebleed); Causes and Management

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Guys. Its medicos is perfection. Alice your favorite medical channel.
This playlist is called called pulmonology and this is video number 7 in this playlist. We have talked about oriented anatomy in two videos then about histology respiratory form ecology co anal. Atresia.
And then todays video is epistaxis. All soon as nosebleed you have you injured a vessel and then you bleed from your nose. What is the cause a variety of etiology even ebola can cause nosebleed.
But please pay attention if you have a patient in your hospital and bleeding from nose. Dont say oh. Its the world is coming to an end shut up.
Its probably. The patient was picking his nose with his finger. Thats why hes having nose bleed okay common things are common people common things are common with that being said now lets get started first lets answer.
The case of the previous video. You have a 72 year old male patient with history of hypertension nosebleed. Right now.
Its severe and the blood pressure is 160 over 100. Whats the next best step in management. Please pause.
And the answer is a blood pressure control posterior packing and vessel ligation. Why because hes an elderly. Hes hypertensive.
Hes having severe nosebleed. This is very different from a young kid who is 3 years old picked his nose with his fingers and now hes bleeding it happened once it never happened again with that you just have like some local pressure and reassurance. If you want to be so.
Generous and vanilla for nasal spray. And thats about it. But when elderly hypertensive patient is bleeding from the nose you better pay attention and act quickly this could be life threatening.
There are two types of nosebleed or epistaxis. Theres anterior epistaxis and posterior epistaxis enters. The more common young patient you do to mucosal dryness foreign body you know kids put anything in their nose or in their mouth.
Or picking with your fingers. And its less significant okay all right. But posterior bleeding is less common however more severe and more significant and happens usually in older patience.
Especially if they are hypertensive and this is bad. Thats why the answer to the case was blood pressure control nasal vessel ligation and posterior packing pasir packing is when you put like a piece of i dont know what they put cotton or something here and you pack it baby you block. It alright cuz.
Its severe so nosebleed two types and tear. Which is the most common posterior less common. But more dangerous symptoms blood coming out of the nose yep.
Its nosebleed. What coming out of the lacrimal ducts. What because those lacrimal dots open into the nasal mediators.
Whats the nasal meeras youre gonna have to watch. My previous video. Okay blood coming out of the mouth and then its called vomiting.
Because its if youre bleeding from your nose. And then blood in your nose your pharynx and then your esophagus you can vomit back through your mouth. But the source was your nose.
But coming out of your ears. What with tool yes again you swallowed your blood esophagus gonna go to the rectum and this is of course. Very rare and the blood is cathartic.
Which will cause diarrhea and this diarrhea is gonna have some dark blood. Why not bright because bright blood is coming from the anus like the source of bleeding is anal rectal. But if the blood is dark.

a nurse is caring for a child who has epistaxis-0
a nurse is caring for a child who has epistaxis-0

It has passed through the stomach because there is acid hematin in the stomach. Which makes the blood dog. If you want to know more about dark blood brown blood bright blood watch my videos on aspirin.
Ive talked about this in detail cool rule of thumb blood is cathartic iron is constipating thats why when you have a patient with iron deficiency anemia and you prescribed iron tablets you say like take three tablets today and then the patients are you know i have been suffering from this anemia for a long time im gonna take seven tablets man whats gonna happen lets fix this iron deficiency anemia and the but when the patient takes seven iron tablets iron is constipating of course the symptoms gonna be im so constipating. My doctor is idiot. Okay.
What kind of defense mechanism is that its called projection. When you understand that this is a defense mechanism. You dont yell at your patient and shout.
And do all of this horrible stuff just try to understand the patient and where theyre coming from and betters become beep useful. Because this is your freaking job doctor. Okay.
Epidemiology bimodal age distribution. You remember there was a disease in hematology with bimodal age distribution. If you say hodgkins lymphoma.
Youre absolutely correct baby okay. Lets talk about epistaxis younger than ten. So here is the graph and here is like zero so younger than ten.
There is a peak and then theres 10 and then older than 50. So heres 50. And there is another peak peak of what of incidence.
If you have a like lets say a child. 5 years old whats the most common is it anterior or posterior. Its an how about an old guy it could be anterior or posterior.
But its hypertensive please suspect posterior. Which one is more common anterior. Which one is more dangerous posterior causes of nosebleed so most commons are here then congee lock.
The inflammatory whatever whatever please dont ever forget this now speaking is by far the most common my kid is bleeding from his knee. I probably put his finger in his nose calm down mamas gonna be okay or for an object in this case you gotta get the foreign object out or blunt trauma. Okay.
When someone punches another person in the face and the rti our upper respiratory tract infection sinusitis rhinitis etc. Coagulopathy anything that will lead to blame thrombocytopenia because of defective primary hemostasis bond or ramsey is defective primary and secondary hemostasis. Why primary cause von willebrand disease is problem with for your fund.
Willebrand factor. The platelets can attach to the endothelium thats a problem with primary hemostasis also involve our brain disease. There is a problem with factor.
8. And factor. It is a factor in the coagulation factors.
Thats why i have problems with primary and secondary hemostasis. Thats why your bleeding time is prolonged. And so is your ptt baby.
What else hemophilia why defective secondary hemostasis problem with the angulation factors. If its haemophilia a its factor. Eight.
If its haemophilia b its factor. Nine its haemophilia c. Turn no wrong 1110 is the most important factor in the calculation.
Youre gonna be deficient in micro. Ten. Youre dead in a second.
Its horrible. So youre saying that factor. Ten deficiency doesnt exist it does exist.
But not in hemophilia. Okay. Leukemia can lead to coghill up at the absolutely inflammatory granulomatosis with polyangiitis formerly known as wagners or wagoners sle lupus of course of course.

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a nurse is caring for a child who has epistaxis-1

Yet ro genic anticoagulant wordfriend. It disrupts the secondary hemostasis heparin. Same thing disrupts.
The secondary hemostasis in supply drugs. Such as cocaine. Big time cocaine can lead to nosebleed and even septal perforation.
You know the nasal septum between your right nostril and left nostril. It can be perforated with cocaine use nasal spray especially steroids for a long time whenever you get steroids tried to give it for a short time as much as you can neoplastic squamous cell. Melanoma adenoids cystic carcinoma and nasopharyngeal carcinoma.
Whats the virus its the ugly epstein barr man traumatic anatomical deformities such a septal spurs blunt trauma. Foreign bodies and nasal bone fracture vascular hurry teri hemorrhagic. Telangiectasia alternates osler webber run dude disease.
Which is an autosomal dominant disease. Right karara are the aneurysm and even an angioma. There is another cause of nosebleed.
Its called angio fibroma. Its not that common but baby this is so bad you so bad because its malignant. Its not malignant its benign.
But the location is horrible. Its in your nose. Theyre lot lots of blood supply in your nose.
And this can can bleed. Its its horrible and you fibrin. So we have four facts here.
If you can grasp these four facts youre an expert in epistaxis. Please pay attention the child. Its probably because hes picking his nose and bleeding from anterior septum.
Whats the treatment local pressure and phenol from spray. Well save the day if its severe and youre packing because its coming from the anterior nose. But see youth or young adult cocaine.
Please dont forget that so whats the treatment posterior packing mnemonic cocaine comes in packages. So you should pack the nose youth or a young adult. There is the horrible juvenile nasopharyngeal ngo fibroma.
Whats the treatment surgical resection is a must not a matter of your opinion. No one cares mnemonic oma. Means mass and you should remove it even though ng fibroma is benign.
It eats and erodes the surrounding structures. You know what panis in rheumatoid arthritis. Its not cancer.
But it eats and erodes the local surrounding structures such as gamma in tertiary syphilis. Its not cancer. But it aids and erodes the surrounding local structures like tuberculoma in tuberculosis.
Which is a granuloma it eats and aroused. The surrounding structures same freakin concept. Now fact number four is by far the most important one elderly patient hypertensive patient huge amount of bleeding.
Whats the treatment blood pressure control posterior packing and vessel ligation you go all in because. This is severe hemorrhage that our life threatening occur in the posterior segment. Whats the artery sphenopalatine.
Which is a branch of the maxillary artery common causes. Include foreign body. Especially if its a kid trauma.
Logic. Finance. Etc.
Etc. Etc. Please remember to remove the foreign body juvenile nasopharyngeal.

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a nurse is caring for a child who has epistaxis-2

Ng. Fibroma is a benign tumor of nasal mucosa. The tumor thats why we called oh man conscious of blood vessel.
Thats why we called angio and fibrous tissue this water called fiber male adolescent is the typical patient perfused nosebleed biopsy may be contraindicated we due to risk of severe hemorrhoids. But again you should talk to your auntie. Im not an expert in this issue because if you ask any pathologists of course of sin and you fibroma on a biopsy before so yeah.
Only the end. He can decide whether or not to biopsy this. So.
Heres case. Number six with two questions here is one the second is in the next page. So where is the first five cases in the previous videos honey.
The playlist is called pulmonology thats why you should watch my videos in orders alright. Three year old. Caucasian bowie presents to your office.
With his parents. Because he coughs cup full of pus. Not just tea sport.
But cup full every day. His parents have to put him in the prone position in order to clear his lung of the pus. His adopted child.
So the family history is not available on speculum exam of the nasal cavity. You notice bilateral nasal polyps. Question.
Number. One. Whats the next best step in management.
Reassurance reported at child. Protective services for suspicion of man showers and syndrome. By proxy order.
A chloride sweat test surgically removed the polyp order. A chromosomal analysis to check for trisomy. 21.
Also known as down syndrome. Prescribed antihistamines decongestants and nasal canula from spray. Please let me know the answer in the comments question number two which of the following is likely to be present in the kid.
Allergic rhinitis hypersensitivity. Pneumonitis. Add to p.
Bowel. Obstruction. Duodenal.
Atresia or co anal atresia. Again let me know the answer in the comment section. And you will find the answer in the next video in this glorious playlist and in the next video.
Well talk about nasal polyps. Because this kid had nasal polyps. So lets talk about nasal polyps.
Lets be honest youre struggling with microbiology legionella mycoplasma pseudomonas rhino virus staff and stripped in all of this crazy stuff pick monic will help you they have animated video like mythical mnemonics. Please see the link in the description below and they are not a sponsor of this video guys i would really appreciate it if you can support my channel on patreon that come mini kosis im gonna send you my cases. My notes and those notes are downloadable so i have audio notes.
I have articles i have these pdf illustrations they are fun thank you for watching. As always be safe stay. Happy.
And study. Hard. This is medical is perfection alice.
Where medicine makes perfect sense. .

a nurse is caring for a child who has epistaxis-3
a nurse is caring for a child who has epistaxis-3

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